非侵入性脑刺激对帕金森病患者步行和平衡能力的影响：一项系统评价和荟萃分析。
Effects of non-invasive brain stimulation on walking and balance ability in Parkinson's patients: A systematic review and meta-analysis.
作者信息
Zhang Xinxin, Jing Feiyue, Liu Yu'ang, Tang Jinyong, Hua Xianfeng, Zhu Jialin, Tuo Haowen, Lin Qihan, Gao Pincao, Liu Weiguo
机构信息
College of Physical Education and Health, Guangxi Normal University, Guilin, China.
出版信息
Front Aging Neurosci. 2023 Jan 10;14:1065126. doi: 10.3389/fnagi.2022.1065126. eCollection 2022.
OBJECTIVE
To investigate and contrast the effects of non-invasive brain stimulation (NIBS), including repeated transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), on walking and balance ability in patients with Parkinson's disease (PD).
METHODS
The PubMed, Embase, Medline, Cochrane, CNKI, and Chinese WanFang databases were searched up to June 2022. Quality assessment was performed using the Cochrane Collaboration's risk-of-bias guidelines, and the standardized mean differences (SMD) or mean differences (MD) for each outcome were calculated.
RESULTS
Among 32 eligible studies, including 1,586 participants were analyzed in this meta-analysis. The results of the meta-analysis showed that NIBS was effective in improving UPDRS-III scores (MD = -2.07; 95% CI, -2.62 to -1.53; < 0.00001; = 6%) and variables associated with the ability of walk such as step width (SMD = 0.35; 95% CI, 0.16-0.55; = 0.0005; = 38%), cadence (SMD = 0.3; 95% CI, 0.05 to 0.55; = 0.02; = 25%), and 6MWT (MD = 62.86; 95% CI, 39.43-86.29; < 0.00001; = 0%). In subgroup analyses across intervention types, UPDRS-III scores (rTMS: MD = -2.54; 95% CI, -3.16 to -1.92; < 0.00001; = 0%; tDCS: MD = -1.20; 95% CI, -1.99 to -0.40; = 0.003; = 0%) and TUGT time (rTMS: MD = -4.11; 95% CI, -4.74 to -3.47; < 0.00001; = 0%; tDCS: MD = -0.84; 95% CI, -1.48 to -0.21; = 0.009; = 0%) significantly improved. Moreover, our results also showed that compared to tDCS, rTMS was more significant in improving UPDRS-III scores and TUGT time ( < 0.05).
CONCLUSION
NIBS benefits some walking ability variables but not balance ability in 36 patients with PD. The rTMS significantly improved UPDRS-III scores and TUGT time compared to tDCS. Further studies are needed to determine the optimal protocol and to illuminate effects based on the ideal target brain regions, stimulation intensity, timing, and type of intervention.
SYSTEMATIC REVIEW REGISTRATION
http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022350782.
目的
探讨并对比非侵入性脑刺激（NIBS），包括重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS），对帕金森病（PD）患者行走和平衡能力的影响。
方法
检索截至2022年6月的PubMed、Embase、Medline、Cochrane、中国知网（CNKI）和中国万方数据库。使用Cochrane协作网的偏倚风险指南进行质量评估，并计算每个结局的标准化均数差（SMD）或均数差（MD）。
结果
在32项符合条件的研究中，本荟萃分析纳入了1586名参与者。荟萃分析结果显示，NIBS能有效改善帕金森病统一评分量表第三部分（UPDRS-III）得分（MD = -2.07；95%置信区间，-2.62至-1.53；P < 0.00001；I² = 6%）以及与行走能力相关的变量，如步幅（SMD = 0.35；95%置信区间，0.16 - 0.55；P = 0.0005；I² = 38%）、步频（SMD = 0.3；95%置信区间，0.05至0.55；P = 0.02；I² = 25%）和6分钟步行试验（6MWT）（MD = 62.86；95%置信区间，39.43 - 86.29；P < 0.00001；I² = 0%）。在不同干预类型的亚组分析中，UPDRS-III得分（rTMS：MD = -2.54；95%置信区间，-3.16至-1.92；P < 0.00001；I² = 0%；tDCS：MD = -1.20；95%置信区间，-1.99至-0.40；P = 0.003；I² = 0%）和起立-行走试验（TUGT）时间（rTMS：MD = -4.11；95%置信区间，-4.74至-3.47；P < 0.00001；I² = 0%；tDCS：MD = -0.84；95%置信区间，-1.48至-0.21；P = 0.009；I² = 0%）均显著改善。此外，我们的结果还表明，与tDCS相比，rTMS在改善UPDRS-III得分和TUGT时间方面更显著（P < 0.05）。
结论
NIBS对36例PD患者的一些行走能力变量有益，但对平衡能力无影响。与tDCS相比，rTMS能显著改善UPDRS-III得分和TUGT时间。需要进一步研究以确定最佳方案，并基于理想的目标脑区、刺激强度、时机和干预类型阐明其效果。
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